Dr. Daniel Velez visits with 11-year-old Gabriel Gonzalez at Phoenix Children's Hospital. Velez performed a heart transplant on the boy, saving his life. Tom Tingle/The Republic

A harrowing and history-making ordeal gives young boy a new heart

Dr. Daniel Velez visits with 11-year-old Gabriel Gonzalez at Phoenix Children's Hospital. Velez performed a heart transplant on the boy, saving his life.
Tom Tingle/The Republic

Dr. Daniel Velez speaks with 11-year-old Gabriel Gonzalez at Phoenix Children's Hospital Feb. 12, 2019. Velez first implanted an artificial heart in Gabriel and following that performed a heart transplant on the boy, saving his life. Tom Tingle/The Republic

A harrowing and history-making ordeal gives young boy a new heart

Dr. Daniel Velez speaks with 11-year-old Gabriel Gonzalez at Phoenix Children's Hospital Feb. 12, 2019. Velez first implanted an artificial heart in Gabriel and following that performed a heart transplant on the boy, saving his life.
Tom Tingle/The Republic

Dr. Daniel Velez greets 11-year-old Gabriel Gonzalez at Phoenix Children's Hospital, Feb. 12, 2019. Velez first implanted an artificial heart in Gabriel and following that performed a heart transplant on the boy, saving his life. Tom Tingle/The Republic

A harrowing and history-making ordeal gives young boy a new heart

Dr. Daniel Velez greets 11-year-old Gabriel Gonzalez at Phoenix Children's Hospital, Feb. 12, 2019. Velez first implanted an artificial heart in Gabriel and following that performed a heart transplant on the boy, saving his life.
Tom Tingle/The Republic

Dr. Daniel Velez speaks with 11-year-old Gabriel Gonzalez at Phoenix Children's Hospital Feb. 12, 2019. Velez first implanted an artificial heart in Gabriel and following that performed a heart transplant on the boy, saving his life.(Photo11: Tom Tingle/The Republic)

'They found a heartbeat'

Anabel Gonzalez was at work when a coworker said a woman had called screaming for help and then hung up. Anabel looked up when a police car sped by in the direction of her mother’s house.

She had a weird feeling. She checked her cell phone and saw she had missed a call. She told her boss, “I’m sorry. I’m leaving.”

There was an ambulance in front of her mother’s house. “What’s going on?” she demanded. A police officer came out of the house and told her, “They found a heartbeat.” Anabel’s heart felt like it stopped.

“What do you mean? What do you mean they found a heartbeat?”

Paramedics wheeled Gabriel out on a gurney, his shirt cut open and an oxygen mask on his face. Anabel climbed into the back of the ambulance with him.

Gabriel's father, Jesus Garcia, got the call at work,45 minutes away, where he was grading a field. He rushed the tractor to the shop and jumped in his car, trying to keep his mind on the road.

“They found a pulse,” Anabel had said on the phone. When Anabel had said something was wrong with Gabriel, Jesus had imagined a cut or broken bone.

Gabriel was healthy. He never missed a check-up. He had been fine the night before when Jesus kissed him goodnight.

CLOSE

Ten-year-old Gabriel Gonzalez first had to receive an artificial heart and followed that with a heart transplant 10 weeks later. Now he’s doing great.
Tom Tingle, The Republic | azcentral.com

A long drive to Phoenix

At Yuma Regional Medical Center, Jesus stopped when he saw his son hooked up to machines, a tube down his throat to help him breathe.

Anabel watched the heart monitor, the numbers jumping, plummeting. She could feel her own heart beating.

Tests showed Gabriel had dilated cardiomyopathy, a condition where the heart muscle thins and the left ventricle — the heart’s main pumping chamber — is enlarged. The heart can’t squeeze efficiently and pump enough blood to the body, leading to cardiac arrest.

The cause isn’t known. In most child cases, it’s myocarditis, an inflammation of the heart muscle that can develop from a virus.

The doctor arranged to send Gabriel by helicopter to Phoenix Children’s Hospital. Its cardiac unit, regarded as one of the best in the nation, was better equipped for what would be required over the coming days and weeks: a series of surgeries rarely performed on a patient so young using innovative technology that would push the boundaries of pediatric medicine.

Anabel rode with Gabriel, holding his hand. Jesus and Rosa followed by car.

Jesus was silent for most of the three-hour drive. Whatever this was, he told himself, his boy would need him to be strong.

Rosa filled in family members on the phone. Rosa never drove over the speed limit. If it is posted 35 miles per hour, she goes 35 miles per hour. But this time, she said, “Jesus, hurry up. Speed! Speed!”

Gabriel Gonzalez was airlifted from Yuma to Phoenix Children's Hospital after he went into cardiac arrest on April 4, 2018. He received a heart transplant on July 4, 2018. Here with a therapy dog and sister Aliyah, 7.(Photo11: Courtesy of Jesus Garcia)

Keeping the panic at bay

Gabriel was sedated and intubated in the intensive care unit when Jesus and Rosa arrived.

Two days later, on April 6, he went into cardiac arrest again. A defibrillator brought him back.

Medication and sedation stabilized his heart for a few days. He could breathe on his own, but the strain on his heart was too much. The breathing tube went back in.

Jesus willed himself not to panic. A former deputy with the Yuma County Sheriff’s Office, he’d learned to keep his emotions in check in tough situations.

His family looked to him for strength and protection. At a time when he felt helpless, he could give his son that at least.

The medication wasn’t working to stabilize his heart rhythm. It was taking larger doses to keep Gabriel sedated.

A week after his second cardiac arrest, it happened again, and again, his heart was stabilized with a defibrillator.

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Dr. Daniel Velez, the hospital’s chief of cardiothoracic surgery, had been monitoring Gabriel’s case. When he passed his room on rounds, he saw Anabel smoothing Gabriel's brow or Jesus showing him a video on a tablet.

The surgeon hadn’t approached Jesus and Anabel because he didn’t want to add to their stress.

Now he had to. Gabriel’s heart was giving out.

'Do what you have to do'

It was April 19. Fifteen days had passed since Gabriel collapsed in his grandmother’s bathroom. Anabel and Jesus had to make a choice.

They could continue this treatment, though Velez worried the medication wasn’t maintaining the boy's heart rhythm, and he didn’t think his heart could take any more shocks.

Or Velez could surgically put in a left ventricular assist device, or LVAD, a mechanical pump that would help his heart pump blood through his body. As with any surgery, there were risks.

“Do what you have to do,” Jesus told Velez. “To us, the more time we’re going to have with him, it’s worth it.”

When Gabriel Gonzalez's heart gave out, Dr. Daniel Velez inserted a device that would pump for him and keep him alive.(Photo11: Courtesy of Phoenix Children's Hospital)

But Velez didn’t have an assist device, not one that would fit in Gabriel’s chest, and the proper unit would take too long to acquire.

Velez knew a doctor in Tucson had used a different device, a transthoracic apical Protek Duo, as a substitute. That patient had been a teenager, as big as an adult, but Velez thought he could make it work.

Within an hour, he'd found one. The surgery would begin that afternoon.

The surgeon trimmed the tubes running from the device to fit the boy. Instead of opening Gabriel’s chest as he would have with an LVAD, Velez inserted the device through a two-inch incision.

While the device normally is used to support the right side of the heart, Velez ran it into Gabriel’s left.

It worked.

“The pump did what his heart couldn’t do,” Velez would say later.

Gabriel became the youngest patient supported with this strategy. He could come off sedatives and mechanical ventilation.

It would keep him alive until a donor heart became available. Velez put Gabriel’s name on the transplant list.

Buying time with technology

Six days after that surgery, Anabel and Jesus faced another choice. Not much of one, really: Gabriel’s heart was out of whack again.

Velez wanted to give Gabriel an artificial heart.

Only a handful of kids had received the new, smaller artificial heart made by Tucson-based SynCardia Systems. Gabriel would be the youngest.

It would be the first Velez had done in his 16 years. He would bring in a world-renowned expert, Francisco Arabia, to supervise.

With an artificial heart in place, Gabriel Gonzalez was up, playing video games and walking down the hall. He lived with the device for 10 weeks before receiving a transplant.(Photo11: Courtesy of Jesus Garcia)

Velez told Jesus and Anabel how it worked, the benefits and the risks.

“If that is going to give us more time with him," Anabel said, "do it.”

In the operating room, Velez removed Gabriel’s heart. It should have been the size of the boy’s fist. It was almost as big as a football.

In a delicate surgery, Velez sewed in the yellow artificial heart. On the monitor, Gabriel flatlined, but in his chest, the artificial heart thumped.

Velez left Gabriel’s chest open to monitor bleeding and let the swelling subside. Anabel couldn’t bring herself to look. Jesus felt like he had to.

“He is the one who went through everything. I would have done anything to switch with him and not have him go through anything,” he said.

“He’s going through all this, the least I can do is go hold his hand."

Now they had time. They could wait for the perfect heart.

Listening for the thump, thump, thump

For Jesus and Anabel, it felt wrong to hope for a donor heart, knowing that someone else had to die for Gabriel to get one.

“Giving us more time meant they run out of theirs,” Jesus said. “If it takes a little longer than what we are expecting, as long as someone else gets to spend another day, another week with their loved one, that’s OK.”

Anabel prayed, though not for a heart. “I would pray for Gabriel just to be here with us,” she said. She listened for the thump, thump, thump of his artificial heart.

The sound was oddly comforting. As long as Jesus and Anabel could hear it, Gabriel was all right.

Within days, Gabriel was up, playing video games and walking down the hall. His color came back. He got stronger. His liver and kidney function improved.

Most days were good. Gabriel could go to the hospital’s play room and even to see the movie “Show Dogs” with friends, He took an extension cord and plugged his artificial heart into an outlet at the theater.

With a battery pack attached to his artificial heart, Gabriel Gonzalez could leave the hospital for short periods of time, even to see "Show Dogs" at the movie theater.(Photo11: Courtesy of Jesus Garcia)

On other days, Gabriel was tired and struggled to breathe.

When Gabriel was unsure, and scared, Jesus would promise, “Hey, man, everything is going to be fine."

Gabriel lived in the hospital with the artificial heart for 10 weeks, past June, into July.

His parents stayed with him, taking turns staying overnight in the hospital while the other parent went to their room at the nearby Ronald McDonald House.

Rosa came with Aliyah on the weekends.

Gabriel was in the waiting room with cousins visiting from Virginia when someone asked for Gabriel. They needed to run some tests.

Anabel ran back to tell Jesus. “Can’t they do it later?” he asked.

“They think they have a heart,” she said.

Jesus sprang up but then reminded himself not to get too excited. “Realistically we’re not going to know if it is 100 percent sure until Dr. Velez sees the heart,” Jesus said. Velez would leave to get the heart in the morning.

That night, the steady thumping of the artificial heart stopped and started. Jesus and Anabel didn't sleep that night, listening for the thump, thump, thump.

'It's a good heart'

Velez left about 7 a.m. He had made this trip hundreds of times.

The team knew the drill: a drive to the airport in an SUV dressed up like an ambulance, lights on top. A chartered plane to the donor's location. A delicate surgery. The return flight. Back into the SUV to the hospital.

Velez is cautious to not give specific details about what time his team left, or how long it took to get there. The identities of organ donors are kept private.

When he left, Gabriel was wheeled to the operating room. Anabel and Jesus walked on either side of the bed.

Gabriel was scared. Jesus was scared, too, but he didn’t tell Gabriel that.

Jesus told Gabriel, “When you wake up, you’re going to have a new heart. Think about that.”

In the operating room, where a surgical team waited with Gabriel, the phone rang.

"It's a good heart," Velez said, and hung up.

The team had four hours, at most, to get the heart on the plane, into the air, back to the hospital in Phoenix and into Gabriel’s chest.

So many things can go wrong, and Velez worried about them all: mechanical problems with the ground transportation or the plane, inclement weather, an accident.

The return trip went smoothly, and Velez was in the operating room with the heart in a cooler by 9 a.m.

In the waiting room, family and friends waited with Jesus and Anabel. As the hours passed, it got dark. Flashes of light painted the sky. Fireworks.

Back in his room, Gabriel slowly woke up. “Did I get my new heart already?” he asked.

"Yes, mijo, you have a new heart,” his mom told him.

The beat-beat-beat of a new heart

Seven months later, Gabriel is louder and less timid than before.

“It’s absolutely like he found himself now,” Jesus said.

He could play sports but, like a lot of 11-year-olds, still prefers video games. He plays outside and rides his bike. He’s not so picky about what he eats. Sometimes, he dances for no reason.

At Phoenix Children’s Hospital on Tuesday for a check-up, Jesus watched his son greet Velez with a fist bump. Later this month, the doctor will present Gabriel’s case at the Society of Clinical Care Medicine conference in San Diego, Calif.

Dr. Daniel Velez greets 11-year-old Gabriel Gonzalez at Phoenix Children's Hospital, Feb. 12, 2019. Velez first implanted an artificial heart in Gabriel and following that performed a heart transplant on the boy, saving his life.(Photo11: Tom Tingle/The Republic)

There is a lot about his stay here that Gabriel doesn’t remember. “I was asleep,” he said. But he is grateful for his new heart.

Gabriel asked Rosa to tell him what happened when he collapsed in the bathroom.

“You saved my life,” he told her.

The tough dad is more emotional now. Even a sappy TV show can set him off.

“I can’t believe I almost lost you," Jesus said. "I can’t believe you’ve been through all of this. You’re here still."

Their life is getting back to normal. Gabriel is back at school with Aliyah, who’s now 7. He takes anti-rejection medication every day. He comes to the hospital once a month for check-ups.

Gabriel hopes to meet the donor’s family one day.

His grandmother told him, “That family is going to be your family as well. They are going to be very welcome to our family. They are going to be our family, too.”

Jesus missed so much work, he lost his job. He is looking for something close to home in case something goes wrong. Family has pitched in, but they are behind on bills.